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GAZETTE
SEPTEMBER 199 0
at any other time, or her capacity
at any other time to form a normal
marriage relationship with an y
other person". He granted th e
Decree.
It seems to me that the situation
in the ecclesiastical courts and the
Civil courts in regard to the granting
of nullity in cases where mental
. . . th e s i tuat i on i n th e
ecclesiastical courts an d th e
Civil courts i n regard t o th e
granting o f nullity when mental
illness exists a t th e time o f
marriage i s roughly similar."
illness exists a t th e time o f
marriage is roughly similar. My im-
pression from experience, however,
is that the ecclesiastical courts take
a broader view in th e case of
personality problems.
Head injury & schizophrenia
The last subject that I will touch
upon is the relationship of trauma
to the aetiology of schizophrenia.
This arises most commonly when
a person who has had a road traffic
accident subsequently develops
schizophrenia. The literature on this
subject is very sparse. For example,
I consulted two recently published
books on the psychological affects
of head injury an d found no re -
ference to schizophrenia in their
indexes. Th e major studies have
been on war time head injuries.
Lishman ha s summed up th e
situation well in discussing the pos-
sible relationship between head
injury an d th e development of
psychoses. H e says "Various
possibilities exist. Organic brain dis-
turbance ma y itself contribute
directly to such developments; or it
may act merely as a precipitant in
someone already predisposed; or
cerebral damage ma y create a
proneness to psychotic disorder by
altering th e subject's pattern of
reaction to stresses and difficulties.
Alternatively, organic factors may
be unimportant in themselves: the
injury or its psychological reper-
cussions may have acted as a non-
specific stress to precipitate the
psychosis, or psychogenic causes
may lie in the changes wrought in
the patient's life or th e special
difficulties he has to face. Finally, of
course, the possibility of simple co-
incidence must also be considered".
The most extensive review of the
literature wa s carried ou t by
Davison and Bagley (1969). Their
conclusions were that th e inci-
dence o f schizophrenia-like psy -
chosis after head injury is certainly
greater than chance expectation,
and that the trauma may often be
of direct aetiological significance
rather than merely a precipitating
factor. The influence of genetic or
personality pre-disposition wa s
found t o be less than in the
naturally occurring disease. Th e
early onset of the psychosis was
related to th e severity of diffuse
brain injury, and a possible special
association with temporal lobe
damage was suggested.
These conclusions are not very
helpful in dealing with th e indi-
vidual case and it is probable that
juries will be inclined to give th e
plaintiff the benefit of the doubt.
In an y individual case i t is
essential to determine whether or
not symptoms were evident before
the accident. It should be deter-
mined whether or not there was a
family history of the disorder, al -
though the evidence regarding its
significance is conflicting. Points in
favour of the injury being of aetio-
logical significance would be if the
brain damage has been extensive
and diffuse with loss of conscious-
ness of over twenty four hours, or
if the damage particularly affects
the temporal lobe, especially the
left. In the latter case there is often
a long latency period before the
onset of the symptoms, whereas in
the former the onset may be early.
The illnesses ar e usually schizo-
phreniform rather than true chronic
deteriorating schizophrenia.
Conclusion
In this paper I have endeavoured to
show that schizophrenia is a very
serious disorder with many forms,
and that i t ma y have serious
medico-legal consequences both
for the sufferer and for those deal-
ing with them.
S. Desmond
McGrath
is
Medical
Director
at St. John
of God
Hospital,
Stillorgan,
Co.
Dublin.
Emeritus
Consultant
Psychiatrist,
Beaumont
Hospital,
Dublin.
* A lecture delivered t o th e
Medico Legal Society o f
Ireland o n 29th January,
1989.
NOTES
1. [1974] I R 55 .
2. [1985] I R 517 .
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